M. Al Maani1, A.L. Spencer1, O. Hejazi1, A. Nelson1, M. Khurshid1, C. Stewart1, S.E. Okosun1, M. Ditillo1, L.J. Magnotti1, B. Joseph1 1University Of Arizona, Division Of Trauma, Critical Care, Burns, And Emergency Surgery/Department Of Surgery, Tucson, AZ, USA
Introduction: The use of alcohol and illicit substances is increasing in the United States. However, it is not clear what proportion of motor vehicle crashes (MVC) are related to driving under the influence (DUI) of alcohol or drugs. The aim of this study was to assess the prevalence and trends of positive drug and alcohol tests among drivers of MVCs admitted to trauma centers across the United States over the years.
Methods: This is a retrospective analysis of the ACS-TQIP database over 4 years (2017-2020). We included patients presenting after an MVC as a driver of vehicles (cars, motorcycles, heavy transport vehicles (HTV), and three-wheeled motor vehicles). Trend analysis was performed for the rates of positive blood or urine toxicology results (Alcohol, Marijuana, Cocaine, Amphetamines, Methamphetamines, and Opiates) among these patients over the years.
Results: Over 4 years, a total of 763,522 MVC drivers with trauma were identified (Adolescents [10-19 yr]: 7.6%; Young Adults [20-64 yr]: 76.7%; Older Adults [≥65 yr]: 15.2%). The mean age was 42 and 70% were male. The median ISS was 9 with an increase over the years from a median of 6 in 2017 to 9 in 2020 (p<0.001). The median GCS was 15 and 20% had a GCS of less than 15 on presentation. Overall, 66% of the victims were car drivers, followed by motorcyclists (25%), HTV drivers (8.6%), and three-wheeled motor vehicle riders (0.4%). Drug or alcohol screening test was positive in 28.8% of drivers, with 36.3% of them testing positive for more than one substance. Overall, alcohol was the most common substance found (47.2%), followed by marijuana (41.5%), and amphetamines (16.3%). Among those with positive screen tests, 68.5% tested positive for drugs other than alcohol, two-thirds (61%) of which tested positive for marijuana. Trend analysis indicated that the incidence of substance abuse-related MVC increased significantly from 27% in 2017 to 32% in 2020 (p<0.001), with the most notable rise in cannabis-abuse-related MVCs (2017:10.2%; 2020:14.6%, p<0.001) (Figure 1). Sub-analysis of different age groups demonstrated the same trend toward increasing DUI-related MVCs, with the most prominent rise in the prevalence of marijuana-positive MVC drivers among adolescents (Figure 2).
Conclusion: Despite policies in place for the prevention of DUI, the prevalence of drug- or alcohol-related MVCs has been increasing over the years, with over one-third of MVC drivers having a positive drug screen on admission in 2020. This surge was even more prominent among adolescents with positive marijuana screen. These findings provide essential epidemiological data as to the prevalence of DUI, which will further inform policymakers to prevent DUI-related MVCs.